Skip to main content

Sluggish Cognitive Tempo and Depressive Symptoms in Children and Adolescents Predict Adulthood Psychopathology

Abstract

Sluggish cognitive tempo (SCT) is characterized by behavioral symptoms reflecting slowness and lethargy (e.g., sluggishness, appearing sleepy) and inconsistent alertness/mental confusion (e.g., daydreaming, fogginess). SCT is substantially correlated with the inattentive symptoms of attention-deficit/hyperactivity disorder (ADHD) and may be part of that domain, but in cross-sectional data, SCT is also strongly associated with both inattention and depression. To date, no study has examined the prospective associations of SCT symptoms in childhood/adolescence with symptoms of ADHD and internalizing problems in adulthood. Using a sample of 449 twin children and adolescent pairs, prospective multiple regression analyses examined whether self- and parent-reported SCT, depression, and parent-reported symptoms of ADHD predicted symptoms in adulthood 12 years later. SCT and depression at time one were strongly correlated (self-reported SCT and depression r = 0.84; parent-reported SCT and depression r = 0.78). When adult outcomes were separately regressed on each youth symptom dimension, self-reported SCT (β = 0.26, p < 0.0001) and depression (β = 0.13, p < 0.0001) each predicted adult symptoms of depression and self-reported SCT predicted inattention (β = 0.12, p = 0.0026). Parent-reported depression, but not parent-reported SCT, predicted self-reported adult depression symptoms (β = 0.17, p = 0.0003). In contrast, when each adult outcome was regressed simultaneously on youth self-reported SCT and depression, neither predicted adulthood inattention or depression. These findings indicate that SCT in childhood and adolescence is strongly associated concurrently and predictively with both inattention and depression. Theoretical and clinical applications of the construct of SCT must take its robust association with both inattention and depression into account.

This is a preview of subscription content, access via your institution.

References

  • Abram, K. M., Zwecker, N. A., Welty, L. J., Hershfield, J. A., Dulcan, M. K., & Teplin, L. A. (2015). Comorbidity and continuity of psychiatric disorders in youth after detention: A prospective longitudinal study. Journal of the American Medical Association Psychiatry, 72, 84–93. https://doi.org/10.1001/jamapsychiatry.2014.1375.

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington: American Psychiatric Association.

  • Barkley, R. A. (2014). Sluggish cognitive tempo (concentration deficit disorder?): Current status, future directions, and a plea to change the name. Journal of Abnormal Child Psychology, 42, 117–125. https://doi.org/10.1007/s10802-013-9824-y.

    Article  PubMed  Google Scholar 

  • Becker, S. P., & Barkley, R. A. (2018). Sluggish cognitive tempo. In T. Banaschewski, D. Coghill, & A. Zuddas (Eds.), Oxford textbook of attention deficit hyperactivity disorder (pp. 147–153). Oxford: Oxford University Press.

    Google Scholar 

  • Becker, S. P., & Willcutt, E. G. (2019). Advancing the study of sluggish cognitive tempo via DSM, RDoC, and hierarchical models of psychopathology. European Child & Adolescent Psychiatry, 28, 603–613.

    Article  Google Scholar 

  • Becker, S. P., Luebbe, A. M., Fite, P. J., Stoppelbein, L., & Greening, L. (2014). Sluggish cognitive tempo in psychiatrically hospitalized children: Factor structure and relations to internalizing symptoms, social problems, and observed behavioral dysregulation. Journal of Abnormal Child Psychology, 42, 49–62.

    Article  Google Scholar 

  • Becker, S. P., Luebbe, A. M., & Joyce, A. M. (2015). The child concentration inventory (CCI): Initial validation of a child self-report measure of sluggish cognitive tempo. Psychological Assessment, 27, 1037–1052. https://doi.org/10.1037/pas0000083.

    Article  PubMed  Google Scholar 

  • Becker, S. P., Leopold, D. R., Burns, G. L., Jarrett, M. A., Langberg, J. M., Marshall, S. A., McBurnett, K., Waschbusch, D. A., & Willcutt, E. G. (2016). The internal, external, and diagnostic validity of sluggish cognitive tempo: A meta-analysis and critical review. Journal of the American Academy of Child and Adolescent Psychiatry, 55, 163–178.

    Article  Google Scholar 

  • Becker, S. P., Garner, A. A., Tamm, L., Antonini, T. N., & Epstein, J. N. (2017). Honing in on the social difficulties associated with sluggish cognitive tempo in children: Withdrawal, peer ignoring, and low engagement. Journal of Clinical Child Adolescent Psychology, 48, 228–237. https://doi.org/10.1080/15374416.2017.1286595.

    Article  PubMed  Google Scholar 

  • Becker, S. P., Burns, G. L., Leopold, D. R., Olson, R. K., & Willcutt, E. G. (2018). Differential impact of trait sluggish cognitive tempo and ADHD inattention in early childhood on adolescent functioning. Journal of Child Psychology and Psychiatry, 59, 1094–1104.

    Article  Google Scholar 

  • Becker, S. P., Webb, K. L., & Dvorsky, M. R. (2019). Initial examination of the bidirectional associations between sluggish cognitive tempo and internalizing symptoms in children. Journal of Clinical Child & Adolescent Psychology. Advanced online publication. https://doi.org/10.1080/15374416.2019.1630836.

  • Becker, S. P., Burns, G. L., Smith, Z. R., & Langberg, J. M. (2020). Sluggish cognitive tempo in adolescents with and without ADHD: Differentiation from adolescent-reported ADHD inattention and unique associations with internalizing domains. Journal of Abnormal Child Psychology, 48, 391–406. https://doi.org/10.1007/s10802-019-00603-9.

    Article  PubMed  Google Scholar 

  • Bernad, M., Servera, M., Becker, S. P., & Burns, G. L. (2016). Sluggish cognitive tempo and ADHD inattention as predictors of externalizing, internalizing, and impairment domains: A 2-year longitudinal study. Journal of Abnormal Child Psychology, 44, 771–785. https://doi.org/10.1007/s10802-015-0066-z.

    Article  Google Scholar 

  • Carlson, C. L., Lahey, B. B., & Neeper, R. (1986). Direct assessment of the cognitive correlates of attention deficit disorders with and without hyperactivity. Journal of Behavioral Assessment and Psychopathology, 8, 69–86.

    Article  Google Scholar 

  • Daoud, J. (2017). Multicollinearity and regression analysis. Journal of Physics: Conference Series, 949, 012009. https://doi.org/10.1088/1742-6596/949/1/012009.

    Article  Google Scholar 

  • Ehringer, M. A., Rhee, S. H., Young, S., Corley, R., & Hewitt, J. K. (2006). Genetic and environmental contributions to common psychopathologies of childhood and adolescence: A study of twins and their siblings. Journal of Abnormal Child Psychology, 34, 1–17.

    Article  Google Scholar 

  • Fassbender, C., Krafft, C. E., & Schweitzer, J. B. (2015). Differentiating SCT and inattentive symptoms of ADHD using fMRI measures of cognitive control. NeuroImage: Clinical, 8, 390–397.

    Article  Google Scholar 

  • Holdaway, A. S., & Becker, S. P. (2018). Sluggish cognitive tempo and student-teacher relationship quality: Short-term longitudinal and concurrent associations. School Psychology Quarterly, 33, 537–546.

    Article  Google Scholar 

  • Korn, E. L., & Graubard, B. I. (1999). Analysis of health surveys. New York: Wiley. https://doi.org/10.1002/9781118032619.

    Book  Google Scholar 

  • Kotov, R., Krueger, R. F., Watson, D., Achenbach, T. M., Althoff, R. R., Bagby, R. M., Brown, T. A., Carpenter, W. T., Caspi, A., Clark, L. A., Eaton, N. R., Forbes, M. K., Forbush, K. T., Goldberg, D., Hasin, D., Hyman, S. E., Ivanova, M. Y., Lynam, D. R., Markon, K., Miller, J. D., Moffitt, T. E., Morey, L. C., Mullins-Sweatt, S. N., Ormel, J., Patrick, C. J., Regier, D. A., Rescorla, L., Ruggero, C. J., Samuel, D. B., Sellbom, M., Simms, L. J., Skodol, A. E., Slade, T., South, S. C., Tackett, J. L., Waldman, I. D., Waszczuk, M. A., Widiger, T. A., Wright, A. G. C., & Zimmerman, M. (2017). The hierarchical taxonomy of psychopathology (HiTOP): A dimensional alternative to traditional nosologies. Journal of Abnormal Psychology, 126, 454–477. https://doi.org/10.1037/abn0000258.

    Article  PubMed  Google Scholar 

  • Laceulle, O. M., Vollebergh, W. A. M., & Ormel, J. (2015). The structure of psychopathology in adolescence: Replication of a general psychopathology factor in the TRAILS study. Clinical Psychological Science, 3, 850–860.

    Article  Google Scholar 

  • Lahey, B. B., Applegate, B., Waldman, I. D., Loft, J. D., Hankin, B. L., & Rick, J. (2004). The structure of child and adolescent psychopathology: Generating new hypotheses. Journal of Abnormal Psychology, 113, 358–385. https://doi.org/10.1037/0021-843X.113.3.358.

    Article  PubMed  Google Scholar 

  • Lahey, B. B., Rathouz, P. J., Van Hulle, C., Urbano, R. C., Krueger, R. F., et al. (2008). Testing structural models of DSM-IV symptoms of common forms of child and adolescent psychopathology. Journal of Abnormal Child Psychology, 36, 187–206.

  • Lahey, B. B., Zald, D. H., Hakes, J. K., Krueger, R. F., Rathouz, P. J. (2014). Patterns of Heterotypic Continuity Associated With the Cross-Sectional Correlational Structure of Prevalent Mental Disorders in Adults. JAMA Psychiatry, 71, 989

  • Lahey, B. B., Krueger, R. F., Rathouz, P. J., Waldman, I. D., & Zald, D. H. (2017). A hierarchical causal taxonomy of psychopathology across the life span. Psychological Bulletin, 2, 142–186.

    Article  Google Scholar 

  • Lee, S. Y., Burns, G. L., Snell, J., & McBurnett, K. (2014). Validity of sluggish cognitive tempo symptom dimension in children: Sluggish cognitive tempo and ADHD-inattention as distinct symptom dimensions. Journal of Abnormal Child Psychology, 42, 7–19.

    Article  Google Scholar 

  • McBurnett, K., Villodas, M., Burns, G. L., Hinshaw, S. P., Beaulieu, A., & Pfiffner, L. J. (2014). Structure and validity of sluggish cognitive tempo using an expanded item pool in children with attention-deficit/hyperactivity disorder. Journal of Abnormal Child Psychology, 42, 37–48. https://doi.org/10.1007/s10802-013-9801-5.

    Article  PubMed  Google Scholar 

  • Moruzzi, S., Rijsdijk, F., & Battaglia, M. (2014). A twin study of the relationships among inattention, hyperactivity-impulsivity, and sluggish cognitive tempo problems. Journal of Abnormal Child Psychology, 42, 63–75.

    Article  Google Scholar 

  • Nimon, K., Henson, R., & Gates, M. (2010). Revisiting interpretation of canonical correlation analysis: A tutorial and demonstration of canonical commonality analysis. Multivariate Behavioral Research, 45, 702–724.

    Article  Google Scholar 

  • Noordhof, A., Krueger, R. F., Ormel, J., Oldehinkel, A. J., & Hartmanm, C. A. (2015). Integrating autism-related symptoms into the dimensional internalizing and externalizing model of psychopathology. The TRAILS study. Journal of Abnormal Child Psychology, 43, 577–587. https://doi.org/10.1007/s10802-014-9923-4.

    Article  PubMed  Google Scholar 

  • Penny, A. M., Waschbusch, D. A., Klein, R. M., Corkum, P., Eskes, G. (2009). Developing a measure of sluggish cognitive tempo for children: Content validity, factor structure, and reliability. Psychological Assessment, 21, 3, 380–389

  • Rutter, M., & Redshaw, J. (1991). Growing up as a twin: Twin–singleton differences in psychological development. Journal of Child Psychology and Psychiatry, 32, 885–895.

    Article  Google Scholar 

  • Sáez, B., Servera, M., Burns, G. L., & Becker, S. P. (2019). Advancing the multi-informant assessment of sluggish cognitive tempo: Child self-report in relation to parent and teacher ratings of SCT and impairment. Journal of Abnormal Child Psychology, 47, 35–46.

    Article  Google Scholar 

  • Servera, M., Bernad, M. D. R., Carrillo, J. M., Collado, S., Burns, L. G. (2015). Longitudinal Correlates of Sluggish Cognitive Tempo and ADHD-Inattention Symptom Dimensions with Spanish Children. Journal of Clinical Child & Adolescent Psychology, 45, 632–641.

  • Servera, M., Sáez, B., Burns, G. L., & Becker, S. P. (2018). Clinical differentiation of sluggish cognitive tempo and attention-deficit/hyperactivity disorder in children. Journal of Abnormal Psychology, 127, 818–829. https://doi.org/10.1037/abn0000375.

    Article  PubMed  PubMed Central  Google Scholar 

  • Shaffer, D., Fisher, P., Lucas, C. P., Dulcan, M. K., & Schwab-Stone, M. E. (2000). NIMH diagnostic interview schedule for children version IV (NIMH DISC-IV): Description, differences from previous versions, and reliability of some common diagnoses. Journal of the American Academy of Child & Adolescent Psychiatry, 39, 28–38. https://doi.org/10.1097/00004583-200001000-00014.

    Article  Google Scholar 

  • Shaffer, D., Fisher, P., Piacentini, J. C., & Lucas, C. (2008). Young adult diagnostic interview schedule for children. New York: Columbia University.

    Google Scholar 

  • Smith, Z. R., & Langberg, J. M. (2017). Predicting academic impairment and internalizing psychopathology using a multidimensional framework of sluggish cognitive tempo with parent- and adolescent-report. Journal of European Child and Adolescent Psychiatry, 27, 1141–1150. https://doi.org/10.1007/s00787-017-1003-1.

    Article  Google Scholar 

  • Smith, Z. R., Becker, S. P., Garner, A. A., Rudolph, C. W., Molitor, S. J., Oddo, L. E., & Langberg, J. M. (2018). Evaluating the structure of sluggish cognitive tempo using confirmatory factor analytic and bifactor modeling with parent and youth ratings. Assessment, 25, 99–111.

    Article  Google Scholar 

  • Smith, Z. R., Eadeh, H. M., Breaux, R. P., & Langberg, J. M. (2019). Sleepy, sluggish, worried, or down? The distinction between self-reported sluggish cognitive tempo, daytime sleepiness, and internalizing symptoms in youth with attention-deficit/hyperactivity disorder. Psychological Assessment, 31, 365–375. https://doi.org/10.1037/pas0000671.

    Article  PubMed  Google Scholar 

  • Ward, A. R., Sibley, M. H., Musser, E. D., Campez, M., Bubnik-Harrison, M. G., Meinzer, M. C., & Yeguez, C. E. (2019). Relational impairments, sluggish cognitive tempo, and severe inattention are associated with elevated self-rated depressive symptoms in adolescents with ADHD. ADHD Attention Deficit and Hyperactivity Disorders, 11, 289–298.

    Article  Google Scholar 

  • Willcutt, E. G., Chhabildas, N., Kinnear, M., DeFries, J. C., & Pennington, B. F. (2014). The internal and external validity of sluggish cognitive tempo and its relation with DSM-IV ADHD. Journal of Abnormal Child Psychology, 42, 21–35.

    Article  Google Scholar 

  • Witkiewitz, K., King, K., McMahon, R. J., Wu, J., Luk, J., Bierman, K. L., et al. (2013). Evidence for a multi-dimensional latent structural model of externalizing disorders. Journal of Abnormal Child Psychology, 41, 223–237. https://doi.org/10.1007/s10802-012-9674-z.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

Supported by Grant MH098098 from the National Institute of Mental Health and CTSA Grants UL1-TR000445 and UL1-TR000430.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Zoe R. Smith.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Smith, Z.R., Zald, D.H. & Lahey, B.B. Sluggish Cognitive Tempo and Depressive Symptoms in Children and Adolescents Predict Adulthood Psychopathology. J Abnorm Child Psychol 48, 1591–1601 (2020). https://doi.org/10.1007/s10802-020-00692-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10802-020-00692-x

Keywords

  • Sluggish cognitive tempo
  • Depression
  • Internalizing psychopathology
  • Inattention
  • Attention-deficit/hyperactivity disorder
  • Longitudinal